Primary Care Providers' Perceptions About Participating in Low-Risk Prostate Cancer Treatment Decisions

Archana Radhakrishnan; Lauren P Wallner; Ted A Skolarus; Paul H Abrahamse; Adam S Kollipara; Steven J Katz; Sarah T Hawley

doi:10.1007/s11606-020-06318-8

Primary Care Providers' Perceptions About Participating in Low-Risk Prostate Cancer Treatment Decisions

J Gen Intern Med. 2021 Feb;36(2):447-454. doi: 10.1007/s11606-020-06318-8. Epub 2020 Oct 29.

Authors

Archana Radhakrishnan¹, Lauren P Wallner^{2

3}, Ted A Skolarus^{4

5}, Paul H Abrahamse², Adam S Kollipara², Steven J Katz^{2

6}, Sarah T Hawley^{2

5

6}

Affiliations

¹ Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA. arra@med.umich.edu.
² Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
³ Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA.
⁴ Department of Urology, University of Michigan, Ann Arbor, MI, USA.
⁵ Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI, USA.
⁶ Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA.

Abstract

Background: Primary care provider's (PCP) role in cancer care is expanding and may include supporting patients in their treatment decisions. However, the degree to which PCPs engage in this role for low-risk prostate cancer is unknown.

Objective: Characterize PCP perceptions regarding their role in low-risk prostate cancer treatment decision-making.

Design: Cross-sectional, national survey.

Main measures: For men with low-risk prostate cancer, PCP reports of (1) confidence in treatment decision-making (high vs. low); (2) intended participation in key aspects of active surveillance treatment decision-making (more vs. less).

Key results: A total of 347 from 741 eligible PCPs responded (adjusted response rate 56%). Half of respondent PCPs (50.3%) reported high confidence about engaging in low-risk prostate cancer treatment decision-making. The odds of PCPs reporting high confidence were greater among those in solo practice (vs working with > 1 PCP) (OR 2.18; 95% CI 1.14-4.17) and with higher volume of prostate cancer patients (> 15 vs. 6-10 in past year) (OR 2.16; 95% CI 1.02-4.61). PCP report of their intended participation in key aspects of active surveillance treatment decision-making varied: discussing worry (62.4%), reviewing benefits (48.5%) and risks (41.8%), and reviewing all treatment options (34.2%). PCPs who reported high confidence had increased odds of more participation in all aspects of active surveillance decision-making: reviewing all treatment options (OR 3.11; 95% CI 1.82-5.32), discussing worry (OR 2.12; 95% CI 1.28-3.51), and reviewing benefits (OR 3.13; 95% CI 1.89-5.16) and risks (OR 3.20; 95% CI 1.91-5.36).

Conclusions: The majority of PCPs were confident about engaging with patients in low-risk prostate cancer treatment decision-making, though their intended participation varied widely across four key aspects of active surveillance care. With active surveillance being considered for other low-risk cancers (such as breast and thyroid), understanding factors influencing PCP involvement will be instrumental to supporting team-based cancer care.

Keywords: decision-making; primary care; prostatic neoplasms; watchful waiting.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Cross-Sectional Studies
Humans
Male
Perception
Physicians, Primary Care*
Primary Health Care
Prostatic Neoplasms* / therapy

Abstract

Publication types

MeSH terms

Grants and funding